Bleeding source identification and treatment in brain arteriovenous malformations

Interv Neuroradiol. 2011 Sep;17(3):323-30. doi: 10.1177/159101991101700307. Epub 2011 Oct 17.

Abstract

Arteriovenous malformation (AVM) patients who initially present with intracerebral haemorrhage may have an identifiable source of bleeding on angiogram, which can be a treatment target. Previous work suggests that the re-bleed rate may be lowered if a weak area is eliminated.A retrospective cohort study was conducted on patients who presented over a six-year period with a bled AVM. Cases were reviewed looking for the source of the hemorrhage by correlating haematoma location on CT or MRI and any angio-architectural weakness seen on digital subtraction angiography (DSA). Neuroendovascular notes were reviewed to identify the treatment targets. One hundred patients presented with a brain AVM with a 1.7:1 male: female ratio, 41 patients had an initial presentation of hemorrhage. The source of hemorrhage was identified in 18 subjects with 11 intranidal false aneurysms, five flow-related aneurysms, two associated aneurysms and one venous pouch. The location of haemorrhage on the presenting scan significantly correlated with the identified bleeding source using Chi-square analysis (P-value 0.039). Partial targeted embolization was used successfully in 90% with a 9% related technical complication rate not resulting in long-term morbidity or mortality. The mean follow-up period was 34 months with an annual hemorrhage rate of 0.7%. In just under half the patients with AVM bleeding a source of haemorrhage can be identified on DSA and in most cases this will be an intranidal false aneurysm. Flow-related and associated aneurysms in patients with brain AVM can cause haemorrhage and these patients are more likely to have SAH than intracerebral haemorrhage.These weak points are a good target for partial endovascular treatment, are usually accessible and may reduce the higher haemorrhage rate expected over the next two years.

MeSH terms

  • Adolescent
  • Adult
  • Angiography, Digital Subtraction
  • Cerebral Angiography
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cerebral Hemorrhage / etiology*
  • Cerebral Hemorrhage / pathology
  • Cerebrovascular Circulation
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / complications*
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / pathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tomography, X-Ray Computed*
  • Young Adult